Case Study: Creating a Win-win with Bona Fide Return-to-work Offers

Does the offer take into account all considerations for it to be bona fide?

An offer to return to work modified duty is beneficial for an injured worker – but only if their individual circumstances are considered.

One of the many benefits of an occupational injury benefit program is injured employees are treated by quality physicians specializing in occupational medicine. Not only are these physicians trained on the protocols for treating occupational injuries, they’re also keenly aware of the physical and psychological benefits of allowing employees to return to work when medically appropriate, be it full duty or modified duty.  

Recently, PartnerSource was asked to advise on a case in which an injured employee was released to modified duty, but the employee refused to return to work. The employer was concerned. Per the terms of the client’s injury benefit plan, an employee is required to timely report to work and perform modified duty in accordance with the approved physician’s assigned work restrictions. If the employee does not do so, the claims administrator shall send the employee a compliance letter reminding them of their responsibilities under the plan.

Was sending the employee a compliance letter an appropriate next step? No, not in this case.

PartnerSource Review

Following a thorough review of the claim file, PartnerSource noted that because of the employee’s right foot injury, they were in a walking boot and their assigned restrictions included no driving. When PartnerSource discussed this with the employer, they acknowledged this restriction was the employee’s main concern: How were they going to get to work if they couldn’t drive?

For an offer of modified duty to be bona fide (in good faith), it must meet all the employee’s work restrictions. In this case, the no-driving restriction had not been factored into the original return to work offer. So, what was the solution? PartnerSource worked with the employer and claims administrator to provide the employee with transportation from a licensed provider, not only to and from their doctor’s visits, but also to and from work.

What other unique circumstances should be considered when determining if an offer of modified duty is bona fide? PartnerSource has had clients ask if an employee can be brought back to work modified duty on a different shift or at a different location. Although most injury benefit plans do not specifically address this, each employee’s unique situation should be considered. 

Those considerations should include:

·      Transportation. If the return to work is at a different location, and the employee has reliable transportation and the alternate location is in the same geographic area, then that would likely be a bona fide offer. However, for example, if the employee does not have a car and typically, before the injury, would ride to work with a coworker, that is a unique situation that should be considered.

• Flexibility. If the return to work is on a different shift and the employee has the flexibility to do so, then that’s likely a bona fide offer. However, if the employee has limited flexibility due to being in school and having classes at the same time, or having a second job during that time period, they may not be able to accept a different shift. The same applies to those caring for a child or elder family member during that period of time. Those are unique situations that should be considered. 
• Ability. If the employee’s restrictions include specific activities they should or should not do, those should also be considered. For example, if they are not supposed to be standing on an injured leg, then that person should not be offered a duty that includes long periods of standing.

Win-win for Everyone

Without taking the time to consider the details, an adjustor might send a compliance letter followed by a denial letter to the employee, with litigation resulting thereafter. 

With years of experience in the Texas Option industry, PartnerSource knows that details are important. When PartnerSource is involved, all aspects of the claim are considered, claim file notes are thoroughly reviewed, and the unique circumstances are considered.

Doing right by the employee is important. The goal is to make sure it’s a bona fide offer that truly meets the employee’s work restrictions and their unique circumstances. Employers need their most valuable resources, their employees, and employees need a job that values their contributions. A bona fide offer that gets them back to work is the best course of action -- then and only then is it a win-win for employer and employee.